New topical molecular targeted therapies for atopic dermatitis in children: A systematic review and meta-analysis

Topical molecular targeted therapies have recently emerged for the treatment of atopic dermatitis (AD), but their efficacy and safety, particularly in children, remain underexplored. This systematic review and meta-analysis aim to evaluate the efficacy and safety of topical targeted therapies in children with AD. We conducted a comprehensive search of the CENTRAL, MEDLINE, Embase, and ICHUSHI databases for articles published up to January 7, 2023, based on a protocol registered in PROSPERO (CRD42022366449). Randomized controlled trials (RCTs) investigating new topical targeted therapies in children (≤18 years) with AD were included. The primary outcomes were the Eczema Area and Severity Index (EASI) scores and treatment-related adverse events. Secondary outcomes included additional efficacy and safety analyses. A meta-analysis was performed using Revman 5.4, with bias risk assessed via the RoB 2 tool. Nine studies (reported in eight articles) involving 2182 patients were included, with 1469 children treated with Janus kinase inhibitors (ruxolitinib and delgocitinib) and phosphodiesterase-4 inhibitors (crisaborole, lotamilast, and difamilast). These interventions significantly improved EASI scores, with the least square mean change (mean difference: -56.67%; 95% confidence interval [-59.16% to -54.18%]). Additionally, topical targeted therapies did not increase the incidence of treatment-emergent adverse events (risk difference: 0.00; 95% confidence interval [-0.02 to 0.02]). The risk of bias was low across all outcomes. New topical targeted therapies administered over 4 weeks are effective and safe for children with atopic dermatitis aged ≤18 years. Further studies are needed to establish their long-term safety and efficacy.